27-month-old boy with eczema. The mother noticed skin alterations on the cheeks and trunk already several months ago, but they were mild and easily treated with baby cream. However, since an upper respiratory infection 2 weeks ago the eczema has become much more severe with intense itching.
Physical examination
Erythematous eruptions on the cheeks. Eczematous lesions behind the ear lobes, showing signs of secondary infection. Extensive involvement of the trunk and extremities showing oozing and crusting, as well as numerous excoriations. No involvement of the scalp.
Suspected diagnosis
Atopic eczema? Secondary infection - Staphylococcus aureus?
Diagnosis & follow-up
Topical application of moistened compresses to oozing lesions, also corticosteroid cream and a 7- day course of oral penicillin. Despite antihistamine therapy, itching and scratching were not effectively controlled and the child continued to exhibit extensive lesions. Phadiatop® Infant was tested positive and IgE antibodies were determined (ImmunoCAP®) to egg white, fish and wheat. The boy was placed on a diet eliminating these foods as well as citrus fruit, tomatoes, tree nuts and peanuts. This diet had a good effect on the eczema and it was now easily treated with emollient lotion. The decreasing level of allergen-specific IgE antibodies later in the follow-up testing did help in deciding when the foods could be reintroduced.
Did you know that
1 out of 3 infants and young children with eczema has underlying allergy and may benefit from a diet or other form of avoidance - which ones are they? Persistent symptoms should always be tested with an allergy blood test.
Reference: Host A et al. Allergy 2003;58:559-69.